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Madagascar recently scaled up their volunteer community health worker (CHW) program in maternal health and family planning to reach remote and underserved communities.

Study design

We conducted a cross-sectional evaluation using a systematic sample of 100 CHWs trained to provide contraceptive counseling and short-acting contraceptive services at the community level. CHWs were interviewed on demographics, recruitment, training, supervision, commodity supply, and other measures of program functionality; tested on knowledge of injectable contraception; and observed by an expert while completing five simulated client encounters with uninstructed volunteers. We developed a CHW performance score (0–100%) based on the number of counseling activities adequately met during the client encounters and used multivariable linear regression to identify correlates of the score.

Results

CHWs had a mean performance score of 73.9% (95% confidence interval [CI]: 70.3–77.6%). More education, more weekly volunteer hours, and receiving a refresher training correlated with a higher performance score. We found no other associations between measures of the components previously identified as essential for effective CHW programs and performance score.

President's Malaria Initiative (U.S.); United States, Agency for International Development.; Centers for Disease Control and Prevention (U.S.);

Published:

April 2012

Description:

Over the past five years, many African countries have reported substantial progress in reducing their burden of malaria. Mortality in children under five years of age has fallen dramatically across sub-Saharan Africa in association with a massive sca...

President's Malaria Initiative (U.S.); United States, Agency for International Development.; Centers for Disease Control and Prevention (U.S.);

Published:

April 2014

Description:

Across sub-Saharan Africa, where countries have scaled up insecticide treated mosquito nets (ITNs), indoor residual spraying (IRS), improved diagnostic tests, and highly effective antimalarial drugs, mortality in children under five years of age has ...

President's Malaria Initiative (U.S.); Centers for Disease Control and Prevention (U.S.); United States, Agency for International Development.;

Published:

April 2011

Description:

Over the past five years, substantial reductions have been recorded in mortality in children under five years of age, buttressed by improvements in malaria-specific indicators in all President's Malaria Initiative (PMI)-supported countries where base...

During August 1985, the Community Health Department of Chogoria Hospital in central Kenya carried out a survey of women of childbearing age throughout the area in which it provides services. This survey, the Chogoria Community Health Survey (CCHS), c...